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Presedo A, Rutz E, Howard JJ, Shrader MW, Miller F. The Etiology of Neuromuscular Hip Dysplasia and Implications for Management: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:844. [PMID: 39062293 PMCID: PMC11275045 DOI: 10.3390/children11070844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
This study summarizes the current knowledge of the etiology of hip dysplasia in children with neuromuscular disease and the implications for management. This article is based on a review of development of the hip joint from embryology through childhood growth. This knowledge is then applied to selective case reviews to show how the understanding of these developmental principles can be used to plan specific treatments. The development of the hip joint is controlled by genetic shape determination, but the final adult shape is heavily dependent on the mechanical environment experienced by the hip joint during growth and development. Children with neuromuscular conditions show a high incidence of coxa valga, hip dysplasia, and subluxation. The etiology of hip pathology is influenced by factors including functional status, muscular tone, motor control, child's age, and muscle strength. These factors in combination influence the development of high neck-shaft angle and acetabular dysplasia in many children. The hip joint reaction force (HJRF) direction and magnitude determine the location of the femoral head in the acetabulum, the acetabular development, and the shape of the femoral neck. The full range of motion is required to develop a round femoral head. Persistent abnormal direction and/or magnitude of HJRF related to the muscular tone can lead to a deformed femoral head and a dysplastic acetabulum. Predominating thigh position is the primary cause defining the direction of the HJRF, leading to subluxation in nonambulatory children. The magnitude and direction of the HJRF determine the acetabular shape. The age of the child when these pathomechanics occur acts as a factor increasing the risk of hip subluxation. Understanding the risk factors leading to hip pathology can help to define principles for the management of neurologic hip impairment. The type of neurologic impairment as defined by functional severity assessed by Gross Motor Function Classification System and muscle tone can help to predict the risk of hip joint deformity. A good understanding of the biomechanical mechanisms can be valuable for treatment planning.
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Affiliation(s)
- Ana Presedo
- Department of Pediatric Orthopaedics, Robert Debré University Hospital, 75019 Paris, France;
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children’s Hospital, Melbourne 3052, Australia;
- Murdoch Children’s Research Institute, Melbourne 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne 3010, Australia
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Jason J. Howard
- Department of Orthopaedics, Nemours Children’s Health, Wilmington, DE 19803, USA; (J.J.H.); (M.W.S.)
| | - Michael Wade Shrader
- Department of Orthopaedics, Nemours Children’s Health, Wilmington, DE 19803, USA; (J.J.H.); (M.W.S.)
| | - Freeman Miller
- Department of Orthopaedics, Nemours Children’s Health, Wilmington, DE 19803, USA; (J.J.H.); (M.W.S.)
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Kostro AM, Augustynik A, Kuryliszyn-Moskal A, Jamiołkowski J, Pocienè M, Dzięcioł-Anikiej Z. Significance of Selected Posturographic Methods in Diagnosis of Balance Disorders in Patients with Early-Stage Gonarthrosis. J Clin Med 2024; 13:3298. [PMID: 38893009 PMCID: PMC11172557 DOI: 10.3390/jcm13113298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Degenerative joint disease is a dynamic pathological process characterised by a destabilisation of the degradation and synthesis processes of articular cartilage and subchondral bone layer. Studies suggest that individuals with gonarthrosis experience deficits in proprioception, in addition to changes within their joints, which directly affects their ability to maintain posture and increases their risk of falling. Objectives: The aim of this study was to assess the functional status of patients with gonarthrosis through a posturographic examination conducted on a stabilometric platform (force plate) and a functional clinical examination. Methods: Participants were divided into two groups-a control group (n = 125) and a study group (n = 125). During the qualification process, subjective and objective examinations were conducted, including a functional assessment by means of such tests as the "Up and Go" Test, Functional Reach Test, Five Time Sit to Stand Test, and the Step Test. Subsequently, an assessment was conducted on the force plate by means of a posturographic test-the Romberg test performed with open and closed eyes in a standing position-and balance was evaluated using the Berg Balance Scale. The obtained data were analysed with the use of the IBM SPSS Statistics software version 27.0, by means of the Mann-Whitney test, and correlations were determined by means of Spearman's test. A significance level of p = 0.05 was adopted. Results: Statistically significant differences were observed among the assessed groups as a result of both functional and posturographic examinations, along with positive correlations for disease duration, age, and BMI index. Conclusions: Patients with gonarthrosis exhibited disturbances in balance, functionality, and posture compared to healthy individuals in the control group.
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Affiliation(s)
- Amanda Maria Kostro
- Rehabilitation Clinic, Medical University of Białystok, 15-089 Białystok, Poland (A.K.-M.)
| | - Artur Augustynik
- Rehabilitation Clinic, Medical University of Białystok, 15-089 Białystok, Poland (A.K.-M.)
| | - Anna Kuryliszyn-Moskal
- Rehabilitation Clinic, Medical University of Białystok, 15-089 Białystok, Poland (A.K.-M.)
| | - Jacek Jamiołkowski
- Population Medicine and Civilisation Disease Prevention Division, Medical University of Białystok, 15-089 Białystok, Poland
| | - Monika Pocienè
- Department of Physiotherapy and Beauty Therapy, Klaipèdos Valstybine Kolegia, 91274 Klaipėda, Lithuania
| | - Zofia Dzięcioł-Anikiej
- Rehabilitation Clinic, Medical University of Białystok, 15-089 Białystok, Poland (A.K.-M.)
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Zhou Z, Shi R, Wang J, Han X, Gao W, Jiao J, Qi Y, Li Y, Zhou Y, Zhao J. Finite Element Analysis of Different Carbon Fiber Reinforced Polyetheretherketone Dental Implants in Implant-supported Fixed Denture. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101902. [PMID: 38685354 DOI: 10.1016/j.jormas.2024.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/27/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES The purpose of this study is to determine the feasibility of polyetheretherketone-based dental implants, and analyze the stress and strain around different kinds of dental implants by finite element analysis. METHODS The radiographic data was disposed to models in Mimics 19.0. 3D models of implants, crowns and jawbones were established and combined in SolidWorks 2018. Appling axial and oblique loads of 100 N, cloud pictures were exported in Ansys Workbench 18.0 to calculate and analyze the stress and strain in and around different implants. RESULTS Oblique load tended to deliver more stress to bone tissue than axial load. The uniformity of stress distribution was the best for 30% short carbon fiber reinforced polyetheretherketone implants at axial and buccolingual directions. Stress shielding phenomenon occurred at the neck of 60% continuous carbon fiber reinforced polyetheretherketone and titanium implants. Stress concentration appeared in PEEK implants and the load of bone tissue would aggravate. CONCLUSIONS 30% short carbon fiber reinforced polyetheretherketone implants demonstrate a more uniform stress distribution in bone-implant contact and surrounding bone than titanium. Stress shielding and stress concentration may be avoided in bone-implant interface and bone tissue. Bone disuse-atrophy may be inhibited in PEEK-based implants.
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Affiliation(s)
- Zhe Zhou
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Ruining Shi
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Junqi Wang
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Xiao Han
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Weijia Gao
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Junjie Jiao
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Yuanzheng Qi
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Yongli Li
- Hospital of Stomatology, Jilin University, Changchun, 130021, China.
| | - Yanmin Zhou
- Hospital of Stomatology, Jilin University, Changchun, 130021, China; Jilin Province Key Laboratory of Tooth Development and Bone Remodeling, Changchun, 130021, China.
| | - Jinghui Zhao
- Hospital of Stomatology, Jilin University, Changchun, 130021, China; Jilin Province Key Laboratory of Tooth Development and Bone Remodeling, Changchun, 130021, China.
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Johnson CC, Dzewaltowski AC, Dever DE, Krajewski KT, Rai A, Ahamed NU, Allison KF, Flanagan SD, Graham SM, Lovalekar M, Anderst WJ, Connaboy C. Load carriage changes tibiofemoral arthrokinematics during ambulatory tasks in recruit-aged women. Sci Rep 2024; 14:9542. [PMID: 38664550 PMCID: PMC11045865 DOI: 10.1038/s41598-024-60187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
The introduction of women into U.S. military ground close combat roles requires research into sex-specific effects of military training and operational activities. Knee osteoarthritis is prevalent among military service members; its progression has been linked to occupational tasks such as load carriage. Analyzing tibiofemoral arthrokinematics during load carriage is important to understand potentially injurious motion and osteoarthritis progression. The study purpose was to identify effects of load carriage on knee arthrokinematics during walking and running in recruit-aged women. Twelve healthy recruit-aged women walked and ran while unloaded (bodyweight [BW]) and carrying additional + 25%BW and + 45%BW. Using dynamic biplane radiography and subject-specific bone models, tibiofemoral arthrokinematics, subchondral joint space and center of closest contact location between subchondral bone surfaces were analyzed over 0-30% stance (separate one-way repeated measures analysis of variance, load by locomotion). While walking, medial compartment contact location was 5% (~ 1.6 mm) more medial for BW than + 45%BW at foot strike (p = 0.03). While running, medial compartment contact location was 4% (~ 1.3 mm) more lateral during BW than + 25%BW at 30% stance (p = 0.04). Internal rotation was greater at + 45%BW compared to + 25%BW (p < 0.01) at 30% stance. Carried load affects tibiofemoral arthrokinematics in recruit-aged women. Prolonged load carriage could increase the risk of degenerative joint injury in physically active women.
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Affiliation(s)
- Camille C Johnson
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex C Dzewaltowski
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Dennis E Dever
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kellen T Krajewski
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajinkya Rai
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nizam U Ahamed
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katelyn F Allison
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Scott M Graham
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Mita Lovalekar
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA.
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Berni M, Marchiori G, Baleani M, Giavaresi G, Lopomo NF. Biomechanics of the Human Osteochondral Unit: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1698. [PMID: 38612211 PMCID: PMC11012636 DOI: 10.3390/ma17071698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
The damping system ensured by the osteochondral (OC) unit is essential to deploy the forces generated within load-bearing joints during locomotion, allowing furthermore low-friction sliding motion between bone segments. The OC unit is a multi-layer structure including articular cartilage, as well as subchondral and trabecular bone. The interplay between the OC tissues is essential in maintaining the joint functionality; altered loading patterns can trigger biological processes that could lead to degenerative joint diseases like osteoarthritis. Currently, no effective treatments are available to avoid degeneration beyond tissues' recovery capabilities. A thorough comprehension on the mechanical behaviour of the OC unit is essential to (i) soundly elucidate its overall response to intra-articular loads for developing diagnostic tools capable of detecting non-physiological strain levels, (ii) properly evaluate the efficacy of innovative treatments in restoring physiological strain levels, and (iii) optimize regenerative medicine approaches as potential and less-invasive alternatives to arthroplasty when irreversible damage has occurred. Therefore, the leading aim of this review was to provide an overview of the state-of-the-art-up to 2022-about the mechanical behaviour of the OC unit. A systematic search is performed, according to PRISMA standards, by focusing on studies that experimentally assess the human lower-limb joints' OC tissues. A multi-criteria decision-making method is proposed to quantitatively evaluate eligible studies, in order to highlight only the insights retrieved through sound and robust approaches. This review revealed that studies on human lower limbs are focusing on the knee and articular cartilage, while hip and trabecular bone studies are declining, and the ankle and subchondral bone are poorly investigated. Compression and indentation are the most common experimental techniques studying the mechanical behaviour of the OC tissues, with indentation also being able to provide information at the micro- and nanoscales. While a certain comparability among studies was highlighted, none of the identified testing protocols are currently recognised as standard for any of the OC tissues. The fibril-network-reinforced poro-viscoelastic constitutive model has become common for describing the response of the articular cartilage, while the models describing the mechanical behaviour of mineralised tissues are usually simpler (i.e., linear elastic, elasto-plastic). Most advanced studies have tested and modelled multiple tissues of the same OC unit but have done so individually rather than through integrated approaches. Therefore, efforts should be made in simultaneously evaluating the comprehensive response of the OC unit to intra-articular loads and the interplay between the OC tissues. In this regard, a multidisciplinary approach combining complementary techniques, e.g., full-field imaging, mechanical testing, and computational approaches, should be implemented and validated. Furthermore, the next challenge entails transferring this assessment to a non-invasive approach, allowing its application in vivo, in order to increase its diagnostic and prognostic potential.
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Affiliation(s)
- Matteo Berni
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gregorio Marchiori
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
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Li X, Chen W, Liu D, Chen P, Wang S, Li F, Chen Q, Lv S, Li F, Chen C, Guo S, Yuan W, Li P, Hu Z. Pathological progression of osteoarthritis: a perspective on subchondral bone. Front Med 2024; 18:237-257. [PMID: 38619691 DOI: 10.1007/s11684-024-1061-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/17/2024] [Indexed: 04/16/2024]
Abstract
Osteoarthritis (OA) is a degenerative bone disease associated with aging. The rising global aging population has led to a surge in OA cases, thereby imposing a significant socioeconomic burden. Researchers have been keenly investigating the mechanisms underlying OA. Previous studies have suggested that the disease starts with synovial inflammation and hyperplasia, advancing toward cartilage degradation. Ultimately, subchondral-bone collapse, sclerosis, and osteophyte formation occur. This progression is deemed as "top to bottom." However, recent research is challenging this perspective by indicating that initial changes occur in subchondral bone, precipitating cartilage breakdown. In this review, we elucidate the epidemiology of OA and present an in-depth overview of the subchondral bone's physiological state, functions, and the varied pathological shifts during OA progression. We also introduce the role of multifunctional signal pathways (including osteoprotegerin (OPG)/receptor activator of nuclear factor-kappa B ligand (RANKL)/receptor activator of nuclear factor-kappa B (RANK), and chemokine (CXC motif) ligand 12 (CXCL12)/CXC motif chemokine receptor 4 (CXCR4)) in the pathology of subchondral bone and their role in the "bottom-up" progression of OA. Using vivid pattern maps and clinical images, this review highlights the crucial role of subchondral bone in driving OA progression, illuminating its interplay with the condition.
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Affiliation(s)
- Xuefei Li
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Wenhua Chen
- Research and Development Center of Chinese Medicine Resources and Biotechnology, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Dan Liu
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Pinghua Chen
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Shiyun Wang
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Fangfang Li
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Qian Chen
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Shunyi Lv
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Fangyu Li
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Chen Chen
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Suxia Guo
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Weina Yuan
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Pan Li
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Zhijun Hu
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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Sheehan FT, Shah P, Boden BP. The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults. Am J Sports Med 2024; 52:1282-1291. [PMID: 38557261 DOI: 10.1177/03635465241233732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. PURPOSE/HYPOTHESIS The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). RESULTS The LPD group demonstrated reduced medial patellar width (Δ = -3.6 mm; P < .001) and medial facet length (Δ = -3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = -3.2 mm; P = .009), decreased patellar volume (Δ = -0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. CONCLUSION The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.
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Affiliation(s)
- Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paras Shah
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Barry P Boden
- The Orthopaedic Center, a Division of CAO, Rockville, Maryland, USA
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Wautier D, Thienpont E. Appearance and evolution of radiolucent lines below the tibial implant in primary total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:1333-1344. [PMID: 37878076 DOI: 10.1007/s00402-023-05100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate total knee arthroplasty (TKA) radiographically to detect the occurrence of radiolucent lines (RLL) under the tibial base plate and to determine what type of RLL may have a correlation with aseptic loosening (AL). The study had two hypotheses: (1) RLLs may have different radiological aspects and evolutions in time depending of different factors (2) Signs of micro- and/or macro-mobility of the implant are necessary before diagnosing aseptic loosening of the tibial component. METHODS Retrospective cohort study of 774 patients operated with a Vanguard TKA (Zimmer Biomet, Warsaw, IN, US) from 2007 to 2015. RLLs were recorded in a database and described according to their radiological aspect, localization, time of apparition, progression and eventual evolution to AL. Other collected parameters were pre- and post-operative HKA angles, amount of post-operative HKA correction, surgical, clinical and demographic data. RESULTS 178/774 TKAs (23%) showed RLLs under the tibial base plate including 9 (1.2%) tibial implants needing revision for AL. Three different types and two aspects of RLLs were observed. Important deformity corrections or undercorrected implants were recognized as a mechanical risk factor for loosening. Elderly women with osteoporosis and young men with important pre-operative deformities were identified as clinical risk factors for RLLs. CONCLUSIONS RLLs are frequently present at the epiphyseal bone/implant interface after total knee arthroplasty, but do not mean the implant is loose. They can be considered a sign of reduced epiphyseal surface fixation due to micro mobility of the tibial implant. Aseptic loosening can be observed radiologically when signs of macro-mobility of the implant are present at the metaphyseal level. LEVEL OF EVIDENCE III.
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Affiliation(s)
- D Wautier
- Department of Orthopedic Surgery, CHU UCL Namur, Godinne, Avenue Docteur Gaston Therasse 1, 5530, Yvoir, Belgium.
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Sauer TJ, McCabe C, Abadi E, Samei E, Segars WP. Surface-based anthropomorphic bone structures for use in high-resolution simulated medical imaging. Phys Med Biol 2023; 69:10.1088/1361-6560/ad1275. [PMID: 38052093 PMCID: PMC10792658 DOI: 10.1088/1361-6560/ad1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/05/2023] [Indexed: 12/07/2023]
Abstract
Objective.Virtual imaging trials enable efficient assessment and optimization of medical image devices and techniques via simulation rather than physical studies. These studies require realistic, detailed ground-truth models or phantoms of the relevant anatomy or physiology. Anatomical structures within computational phantoms are typically based on medical imaging data; however, for small and intricate structures (e.g. trabecular bone), it is not reasonable to use existing clinical data as the spatial resolution of the scans is insufficient. In this study, we develop a mathematical method to generate arbitrary-resolution bone structures within virtual patient models (XCAT phantoms) to model the appearance of CT-imaged trabecular bone.Approach. Given surface definitions of a bone, an algorithm was implemented to generate stochastic bicontinuous microstructures to form a network to define the trabecular bone structure with geometric and topological properties indicative of the bone. For an example adult male XCAT phantom (50th percentile in height and weight), the method was used to generate the trabecular structure of 46 chest bones. The produced models were validated in comparison with published properties of bones. The utility of the method was demonstrated with pilot CT and photon-counting CT simulations performed using the accurate DukeSim CT simulator on the XCAT phantom containing the detailed bone models.Main results. The method successfully generated the inner trabecular structure for the different bones of the chest, having quantiative measures similar to published values. The pilot simulations showed the ability of photon-counting CT to better resolve the trabecular detail emphasizing the necessity for high-resolution bone models.Significance.As demonstrated, the developed tools have great potential to provide ground truth simulations to access the ability of existing and emerging CT imaging technology to provide quantitative information about bone structures.
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Affiliation(s)
- Thomas J Sauer
- Center for Virtual Imaging Trials, Duke University, Durham NC, United States of America
| | - Cindy McCabe
- Center for Virtual Imaging Trials, Duke University, Durham NC, United States of America
| | - Ehsan Abadi
- Center for Virtual Imaging Trials, Duke University, Durham NC, United States of America
| | - Ehsan Samei
- Center for Virtual Imaging Trials, Duke University, Durham NC, United States of America
| | - W Paul Segars
- Center for Virtual Imaging Trials, Duke University, Durham NC, United States of America
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Wen Y, Latham CM, Moore AN, Thomas NT, Lancaster BD, Reeves KA, Keeble AR, Fry CS, Johnson DL, Thompson KL, Noehren B, Fry JL. Vitamin D status associates with skeletal muscle loss after anterior cruciate ligament reconstruction. JCI Insight 2023; 8:e170518. [PMID: 37856482 PMCID: PMC10795826 DOI: 10.1172/jci.insight.170518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUNDAlthough 25-hydroxyvitamin D [25(OH)D] concentrations of 30 ng/mL or higher are known to reduce injury risk and boost strength, the influence on anterior cruciate ligament reconstruction (ACLR) outcomes remains unexamined. This study aimed to define the vitamin D signaling response to ACLR, assess the relationship between vitamin D status and muscle fiber cross-sectional area (CSA) and bone density outcomes, and discover vitamin D receptor (VDR) targets after ACLR.METHODSTwenty-one young, healthy, physically active participants with recent ACL tears were enrolled (17.8 ± 3.2 years, BMI 26.0 ± 3.5 kg/m2). Data were collected through blood samples, vastus lateralis biopsies, dual energy x-ray bone density measurements, and isokinetic dynamometer measures at baseline, 1 week, 4 months, and 6 months after ACLR. The biopsies facilitated CSA, Western blotting, RNA-seq, and VDR ChIP-seq analyses.RESULTSACLR surgery led to decreased circulating bioactive vitamin D and increased VDR and activating enzyme expression in skeletal muscle 1 week after ACLR. Participants with less than 30 ng/mL 25(OH)D levels (n = 13) displayed more significant quadriceps fiber CSA loss 1 week and 4 months after ACLR than those with 30 ng/mL or higher (n = 8; P < 0.01 for post hoc comparisons; P = 0.041 for time × vitamin D status interaction). RNA-seq and ChIP-seq data integration revealed genes associated with energy metabolism and skeletal muscle recovery, potentially mediating the impact of vitamin D status on ACLR recovery. No difference in bone mineral density losses between groups was observed.CONCLUSIONCorrecting vitamin D status prior to ACLR may aid in preserving skeletal muscle during recovery.FUNDINGNIH grants R01AR072061, R01AR071398-04S1, and K99AR081367.
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Affiliation(s)
- Yuan Wen
- Center for Muscle Biology, College of Health Sciences
- Department of Physiology, College of Medicine
- Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine
| | | | | | | | | | | | - Alexander R. Keeble
- Center for Muscle Biology, College of Health Sciences
- Department of Physiology, College of Medicine
| | | | | | - Katherine L. Thompson
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Brian Noehren
- Center for Muscle Biology, College of Health Sciences
- Department of Orthopaedic Surgery & Sports Medicine, and
| | - Jean L. Fry
- Center for Muscle Biology, College of Health Sciences
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11
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Yang K, Ding Y, Xu H, Lai M, Xu X, Yu X, Deng Q, Jiang L. Efficacy and safety of platelet-rich plasma combined with Tai Chi for knee osteoarthritis: study protocol for a placebo-controlled randomized trial. J Orthop Surg Res 2023; 18:885. [PMID: 37990325 PMCID: PMC10662628 DOI: 10.1186/s13018-023-04372-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND No definitive treatment methods of curative for knee osteoarthritis (KOA). The combined therapies that into account both the biochemical and biomechanical may provide potential opportunities for treat KOA, and previous studies have demonstrated that the platelet-rich plasma of intra-articular injection (IAI-PRP) and exercise treatments afford more benefits than do their corresponding monotherapies. The absence of a specific exercise plan and detailed explanation renders the aforementioned study results questionable. Furthermore, Tai Chi (TC) with moderate-intensity, whole body movements and good adherence may prove to be more effective for treating KOA. However, few studies examined the effectiveness and safety of combined IAI-PRP and TC for KOA. METHODS This study protocol will be a placebo-controlled, assessor-blinded randomized trial involving 12-week intervention and 1-year follow-up. The stratified randomization will be used to randomly assign the 212 participants to four groups: group A (placebo IAI); group B (PRP IAI); group C (TC and placebo IAI); group D (TC and PRP IAI). Injection will be performed once a week, three consecutive times as a course, after a week of rest to continue the next course, a total of 3 courses (12 week). Additionally, the TC interventions will be carried out 3 days per week for a total of 12 weeks. The primary outcome measures will include the efficacy (Western Ontario and McMaster Universities Osteoarthritis Index), acceptability and safety of these interventions. The secondary outcome measures will include physical function (Timed Up and Go test), walking function (Gait Analysis), inflammatory factor levels (e.g., Interleukin-1 β, interleukin-6, vascular endothelial growth factor), quality of life (36-Item Short Form Health Survey), volume of patellofemoral cartilage and effusion-synovitis (MRI). Two-way of variance with repeated measures will be applied to examine the main effects of the group and the time factor and group-time interaction effects for all outcome measures. DISCUSSION This trial will be first one to propose an integrated scheme combing IAI-PRP and TC for treatment of KOA, based on the consideration of the biochemical and biomechanical pathogenesis of KOA. These results of the study will provide evidence with high quality for integrated IAI-PRP and TC to treatment KOA. Trial Registration Chinese Clinical Trial Registry ChiCTR2300067559. Registered on 11 January 2023.
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Affiliation(s)
- Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuwu Ding
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haichen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Minghui Lai
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xueping Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Deng
- School of Health and Nursing, Wuxi Taihu University, Wuxi, China
| | - Liming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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12
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Modina SC, Aidos L, Millar VRH, Pallaoro M, Polito U, Veronesi MC, Peretti GM, Mangiavini L, Carnevale L, Boschetti F, Abbate F, Di Giancamillo A. Postnatal morpho-functional development of a dog's meniscus. Ann Anat 2023; 250:152141. [PMID: 37499701 DOI: 10.1016/j.aanat.2023.152141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
This study evaluates the morpho-functional modifications that characterize meniscal development from neonatal to adult dogs. Even if menisci are recognized as essential structures for the knee joint, poor information is available about their morphogenesis, in particular in dog models. Menisci from a group of Dobermann Pinchers aged 0, 10, 30 days, and 4 years (T0, T10, T30, adult, respectively) were analyzed by SEM, histochemistry (Safranin O and Picro Sirius Red Staining analyzed under a polarized light microscope), immunofluorescences (collagen type I and II), biomechanical (compression) and biochemical analyses (glycosaminoglycans, GAGs, and DNA content). SEM analyses revealed that the T0 meniscus is a bulgy structure that during growth tends to flatten, firstly in the inner zone (T10) and then even in the outer zone (T30), until the achievement of the completely smooth adult final shape. These results were further supported by the histochemistry analyses in which the deposition of GAGs started from T30, and the presence of type I birefringent collagen fibers was observed from T0 to T30, while poorly refringent type III collagen fibers were observed in the adult dogs. Double immunofluorescence analyses also evidenced that the neonatal meniscus contains mainly type I collagen fibers, as well as the T10 meniscus, and demonstrated a more evident regionalization and crimping in the T30 and adult meniscus. Young's elastic modulus of the meniscus in T0 and T10 animals was lower than the T30 animals, and this last group was also lower than adult ones (T0-T10 vs T30 vs adult). Biochemical analysis confirmed that cellularity decreases over time from neonatal to adult (p < 0.01). The same decreasing trend was observed in GAGs deposition. These results may suggest that the postnatal development of canine meniscus may be related to the progressive functional locomotory development: after birth, the meniscus acquires its functionality over time, through movement, load, and growth itself.
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Affiliation(s)
- Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Lucia Aidos
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | | | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Umberto Polito
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Maria Cristina Veronesi
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Liliana Carnevale
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Federica Boschetti
- IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Polytechnic University of Milan, 20133 Milan, Italy
| | - Francesco Abbate
- Department of Veterinary Sciences, University of Messina, Polo Universitario S.S. Annunziata, 98168 Messina, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy.
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He MC, Tian JQ, He XM, Yang P, Lin TY, Zhang QW, He W, Wei QS. Mechanical properties of trabeculae and osteocyte morphology change significantly in different areas of the necrotic femoral head. Front Cell Dev Biol 2023; 11:1250070. [PMID: 37822871 PMCID: PMC10562544 DOI: 10.3389/fcell.2023.1250070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Background: Osteonecrosis of the femoral head is a complex hip ailment. The precise changes in bone tissue during the disease's onset remain unclear. It is vital to assess both the quantity and quality of the trabecular state in a necrotic femoral head. Aim: This study aims to identify and compare the ultrastructural changes in osteocyte morphology and nanomechanical characteristics within various regions of necrotic femoral heads. Methods: Between December 2016 and May 2023, we gathered ten necrotic femoral heads from patients and five femoral heads from cadavers. The samples from the necrotic femoral heads were categorized into three areas: necrotic, sclerotic, and normal. Our assessment methods encompassed hematoxylin and eosin staining, sclerostin (SOST) immunohistochemistry, micro-computed tomography, nanoindentation, and acid-etched scanning electron microscopy. These techniques enabled us to examine the SOST expression, trabecular microstructure, micromechanical properties of trabeculae, and modifications in osteocyte morphology at the ultrastructural level. Results: The protein level of SOST was found to be lower in the sclerotic area. In the necrotic area, decreased values of bone volume fraction, trabecular thickness, and trabecular number and an increased value of trabecular separation were found. Conversely, in the sclerotic area, higher mean values of bone volume fraction, trabecular number, and trabecular thickness and lower trabecular separation indicated significant changes in the structural characteristics of trabeculae. Compared with the healthy area, the elastic modulus and hardness in the sclerotic area were significantly higher than those in the necrotic, normal, and control areas, while those in necrotic areas were significantly lower than those in the healthy area. The number of osteocytes tended to increase in the sclerotic area with more canalicular cells compared to the healthy area and control group. Conclusion: These results imply that the stress distribution within the sclerotic area could potentially lead to enhanced trabecular quality and quantity. This effect is also reflected in the increased count of osteocytes and their canaliculars. It is plausible that the sclerotic trabecular bone plays a pivotal role in the repair of necrotic femoral heads.
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Affiliation(s)
- Min-Cong He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia-Qing Tian
- The Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Ming He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Yang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian-Ye Lin
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing-Wen Zhang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu-Shi Wei
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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Brent MB. Pharmaceutical treatment of bone loss: From animal models and drug development to future treatment strategies. Pharmacol Ther 2023; 244:108383. [PMID: 36933702 DOI: 10.1016/j.pharmthera.2023.108383] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/18/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
Animal models are fundamental to advance our knowledge of the underlying pathophysiology of bone loss and to study pharmaceutical countermeasures against it. The animal model of post-menopausal osteoporosis from ovariectomy is the most widely used preclinical approach to study skeletal deterioration. However, several other animal models exist, each with unique characteristics such as bone loss from disuse, lactation, glucocorticoid excess, or exposure to hypobaric hypoxia. The present review aimed to provide a comprehensive overview of these animal models to emphasize the importance and significance of investigating bone loss and pharmaceutical countermeasures from perspectives other than post-menopausal osteoporosis only. Hence, the pathophysiology and underlying cellular mechanisms involved in the various types of bone loss are different, and this might influence which prevention and treatment strategies are the most effective. In addition, the review sought to map the current landscape of pharmaceutical countermeasures against osteoporosis with an emphasis on how drug development has changed from being driven by clinical observations and enhancement or repurposing of existing drugs to today's use of targeted anti-bodies that are the result of advanced insights into the underlying molecular mechanisms of bone formation and resorption. Moreover, new treatment combinations or repurposing opportunities of already approved drugs with a focus on dabigatran, parathyroid hormone and abaloparatide, growth hormone, inhibitors of the activin signaling pathway, acetazolamide, zoledronate, and romosozumab are discussed. Despite the considerable progress in drug development, there is still a clear need to improve treatment strategies and develop new pharmaceuticals against various types of osteoporosis. The review also highlights that new treatment indications should be explored using multiple animal models of bone loss in order to ensure a broad representation of different types of skeletal deterioration instead of mainly focusing on primary osteoporosis from post-menopausal estrogen deficiency.
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Affiliation(s)
- Mikkel Bo Brent
- Department of Biomedicine, Aarhus University, Denmark, Wilhelm Meyers Allé 3, 8000 Aarhus C, Denmark.
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15
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Liang H, Qi W, Jin C, Pang Q, Cui L, Jiang Y, Wang O, Li M, Xing X, Liu W, Xia W. A Chinese case of CHST3-related skeletal dysplasia and a systematic review. Endocrine 2023; 80:658-668. [PMID: 36729370 DOI: 10.1007/s12020-023-03303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE We reported a case with carbohydrate sulfotransferase 3 (CHST3) spondyloepiphyseal dysplasia and made a systematic review of all previously reported cases. METHODS A 14.8-year-old boy underwent clinical, radiological, and genetic evaluations. The patients and five age-matched healthy boys accepted high-resolution peripheral quantitative computed tomography evaluation. All CHST3-related skeletal dysplasia cases from PubMed and Embase were collected and summarized. The genotype-phenotype correlation was analyzed. RESULTS The proband complained of aggravated joint pain and had a compression fracture of L2 during his second decade. Physical examination showed a height Z score of -4.94, short limbs, and restricted movement of the elbows and knees. X-rays showed carpal epiphyseal dysplasia, enlargement of elbow and knee joints, and subluxation of the left hip. Echocardiography showed abnormal cardiac valves. Compared with the norm, his total and trabecular volumetric bone mineral density (BMD), and the microarchitecture of the trabecular bone had trends to be worse at the distal radius and tibia. Two novel missense variants of c.1343T>G and c.761C>G in CHST3 were inherited from his father and mother, respectively. In the systematic review, short stature, limited joint extension, joint pain, and joint dislocation were the most common characteristics of this disorder. Height Z score and the proportion of hearing impairment had no significant differences between the missense and nonmissense mutations groups. CONCLUSION Progressive joint pain and movement restriction are the main characteristics of CHST3-related skeletal dysplasia. BMD and bone microarchitecture of this disorder needs further exploration. There is no apparent genotype-phenotype correlation in this disorder.
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Affiliation(s)
- Hanting Liang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenting Qi
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenxi Jin
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Endocrinology and Metabolism, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Qianqian Pang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijia Cui
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Liu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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16
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Indications and Timing of Guided Growth Techniques for Pediatric Upper Extremity Deformities: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020195. [PMID: 36832323 PMCID: PMC9954695 DOI: 10.3390/children10020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Osseous deformities in children arise due to progressive angular growth or complete physeal arrest. Clinical and radiological alignment measurements help to provide an impression of the deformity, which can be corrected using guided growth techniques. However, little is known about timing and techniques for the upper extremity. Treatment options for deformity correction include monitoring of the deformity, (hemi-)epiphysiodesis, physeal bar resection, and correction osteotomy. Treatment is dependent on the extent and location of the deformity, physeal involvement, presence of a physeal bar, patient age, and predicted length inequality at skeletal maturity. An accurate estimation of the projected limb or bone length inequality is crucial for optimal timing of the intervention. The Paley multiplier method remains the most accurate and simple method for calculating limb growth. While the multiplier method is accurate for calculating growth prior to the growth spurt, measuring peak height velocity (PHV) is superior to chronological age after the onset of the growth spurt. PHV is closely related to skeletal age in children. The Sauvegrain method of skeletal age assessment using elbow radiographs is possibly a simpler and more reliable method than the method by Greulich and Pyle using hand radiographs. PHV-derived multipliers need to be developed for the Sauvegrain method for a more accurate calculation of limb growth during the growth spurt. This paper provides a review of the current literature on the clinical and radiological evaluation of normal upper extremity alignment and aims to provide state-of-the-art directions on deformity evaluation, treatment options, and optimal timing of these options during growth.
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17
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Doyle ME, Dalgarno K, Masoero E, Ferreira AM. Advances in biomimetic collagen mineralisation and future approaches to bone tissue engineering. Biopolymers 2023; 114:e23527. [PMID: 36444710 PMCID: PMC10078151 DOI: 10.1002/bip.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
With an ageing world population and ~20% of adults in Europe being affected by bone diseases, there is an urgent need to develop advanced regenerative approaches and biomaterials capable to facilitate tissue regeneration while providing an adequate microenvironment for cells to thrive. As the main components of bone are collagen and apatite mineral, scientists in the tissue engineering field have attempted in combining these materials by using different biomimetic approaches to favour bone repair. Still, an ideal bone analogue capable of mimicking the distinct properties (i.e., mechanical properties, degradation rate, porosity, etc.) of cancellous bone is to be developed. This review seeks to sum up the current understanding of bone tissue mineralisation and structure while providing a critical outlook on the existing biomimetic strategies of mineralising collagen for bone tissue engineering applications, highlighting where gaps in knowledge exist.
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Affiliation(s)
| | - Kenny Dalgarno
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
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18
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Wang H, Sun Z, Wang L, Zou D, Li W. Proximal Fusion Level Above First Coronal Reverse Vertebrae: An Essential Factor Decreasing the Risk of Adjacent Segment Degeneration in Degenerative Lumbar Scoliosis. Global Spine J 2023; 13:149-155. [PMID: 33648368 PMCID: PMC9837505 DOI: 10.1177/2192568221994082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective radiological analysis. OBJECTIVE To explore whether proximal fusion level above first coronal reverse vertebrae (FCRV) could decrease risk of adjacent segment degeneration (ASD) in degenerative lumbar scoliosis (DLS). METHODS One hundred and 16 DLS patients were divided into 2 groups according to occurrence of ASD: study group (ASD positive group) and control group (ASD negative group). FCRV was defined as the first vertebrae that presents opposite orientation of asymmetric Hounsfield unit (HU) ratio from the other vertebrae within major curve. Incidence of ASD was evaluated in subgroups according to location between FCRV and upper instrumented vertebrae (UIV). RESULTS The fusion level was shorter in study group than that in control group. There were 12 patients presented FCRV 2-level proximal than SV, 32 patients presented FCRV 1-level proximal than SV, 35 patients presented the same vertebra of FCRV with SV, 23 patients presented FCRV 1-level distal than SV, 14 patients presented FCRV 2-level distal than SV. When UIV located above FCRV, no patient presented ASD, while 15.4% patients presented ASD when UIV located on FCRV. In study group, proximal scoliosis progression was detected in 1 patient (3.9%) when UIV located on FCRV, and 17 patients (29.8%) when UIV located below FCRV. CONCLUSIONS Proximal fusion level above FCRV could decrease the risk of ASD in DLS, especially for the proximal scoliosis progression. FCRV represent the transitional point of the mechanical load on coronal plane, and may be within a more stable condition than stable vertebrae measured from radiographs.
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Affiliation(s)
- Hui Wang
- Orthopaedic Department of Peking
University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease
Research, Beijing, China,Engineering Research Center of Bone and
Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department of Peking
University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease
Research, Beijing, China,Engineering Research Center of Bone and
Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Longjie Wang
- Orthopaedic Department of Peking
University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease
Research, Beijing, China,Engineering Research Center of Bone and
Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Da Zou
- Orthopaedic Department of Peking
University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease
Research, Beijing, China,Engineering Research Center of Bone and
Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- Orthopaedic Department of Peking
University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease
Research, Beijing, China,Engineering Research Center of Bone and
Joint Precision Medicine, Ministry of Education, Beijing, China,Weishi Li, MD, Orthopaedic Department of
Peking University Third Hospital, No 49. North Garden Street, HaiDian District
100191, Beijing, China.
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19
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Zhou M, Graves DT. Impact of the host response and osteoblast lineage cells on periodontal disease. Front Immunol 2022; 13:998244. [PMID: 36304447 PMCID: PMC9592920 DOI: 10.3389/fimmu.2022.998244] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
Periodontitis involves the loss of connective tissue attachment and alveolar bone. Single cell RNA-seq experiments have provided new insight into how resident cells and infiltrating immune cells function in response to bacterial challenge in periodontal tissues. Periodontal disease is induced by a combined innate and adaptive immune response to bacterial dysbiosis that is initiated by resident cells including epithelial cells and fibroblasts, which recruit immune cells. Chemokines and cytokines stimulate recruitment of osteoclast precursors and osteoclastogenesis in response to TNF, IL-1β, IL-6, IL-17, RANKL and other factors. Inflammation also suppresses coupled bone formation to limit repair of osteolytic lesions. Bone lining cells, osteocytes and periodontal ligament cells play a key role in both processes. The periodontal ligament contains cells that exhibit similarities to tendon cells, osteoblast-lineage cells and mesenchymal stem cells. Bone lining cells consisting of mesenchymal stem cells, osteoprogenitors and osteoblasts are influenced by osteocytes and stimulate formation of osteoclast precursors through MCSF and RANKL, which directly induce osteoclastogenesis. Following bone resorption, factors are released from resorbed bone matrix and by osteoclasts and osteal macrophages that recruit osteoblast precursors to the resorbed bone surface. Osteoblast differentiation and coupled bone formation are regulated by multiple signaling pathways including Wnt, Notch, FGF, IGF-1, BMP, and Hedgehog pathways. Diabetes, cigarette smoking and aging enhance the pathologic processes to increase bone resorption and inhibit coupled bone formation to accelerate bone loss. Other bone pathologies such as rheumatoid arthritis, post-menopausal osteoporosis and bone unloading/disuse also affect osteoblast lineage cells and participate in formation of osteolytic lesions by promoting bone resorption and inhibiting coupled bone formation. Thus, periodontitis involves the activation of an inflammatory response that involves a large number of cells to stimulate bone resorption and limit osseous repair processes.
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Affiliation(s)
- Mi Zhou
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Dana T. Graves
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Dana T. Graves,
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20
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Wang C, Sun B, Zhang Y, Wang C, Yang G. Design of a Novel Trabecular Acetabular Cup and Selective Laser Melting Fabrication. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15176142. [PMID: 36079522 PMCID: PMC9457748 DOI: 10.3390/ma15176142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 06/01/2023]
Abstract
The acetabular cups used in total hip arthroplasty are mostly made of dense metal materials with an elastic moduli much higher than that of human bone. This leads to stress shielding after implantation, which may cause aseptic loosening of the implant. Selective laser melting (SLM) technology allows us to produce tiny and complex porous structures and to reduce the elastic moduli of dense metals, thereby avoiding stress shielding. In the present study, rhombic dodecahedron porous structures with cell sizes of 1 mm, 1.5 mm, and 2 mm were designed. The strut diameter was changed to ensure that the porosity and pore size would meet the bone ingrowth requirements. Then, porous Ti6Al4V alloy specimens were printed using SLM, and compressive tests were carried out. The results showed that the compressive strength and elastic modulus values of the specimens with a cell size of 1.5 mm were in the range of 78.16-242.94 MPa and 1.74-4.17 GPa, respectively, which are in line with the mechanical properties of human cortical bone. Finite element analysis of a total hip joint model was carried out to simulate gait, and the surface of the trabecular acetabular cup was divided into 10 regions according to the stress distribution, with the stress interval in the range of 37.44-219.24 MPa. According to the compression test results, the gradient structure of Ti6Al4V alloy with different porosity was designed for trabecular coating. The gradient porous structure meets the mechanical requirements and is closer to the natural structure of human bone than the uniformly distributed porous structure.
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Affiliation(s)
| | | | - Yongdi Zhang
- Correspondence: (Y.Z.); (G.Y.); Tel.: +86-0311-81668663 (Y.Z.); +86-0311-81668632 (G.Y.)
| | | | - Guang Yang
- Correspondence: (Y.Z.); (G.Y.); Tel.: +86-0311-81668663 (Y.Z.); +86-0311-81668632 (G.Y.)
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21
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(Bio)Tribocorrosion in Dental Implants: Principles and Techniques of Investigation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Tribocorrosion is a current and very discussed theme in tribology and medicine for its impact on industrial applications. Currently, the phenomena are mainly oriented to the biological environment and, in particular, to medical devices such as hip prostheses, dental implants, knee joints, etc. The term tribocorrosion underlines the simultaneous action of wear and corrosion in a tribocouple. It has a non-negligible effect on the total loss of contact materials and the potential failure of the bio-couplings. This overview aims to focus firstly on the basic principles of prosthesis tribocorrosion and subsequently to describe the techniques and the analytical models developed to quantify this phenomenon, reporting the most relevant results achieved in the last 20 years, proposed in chronological order, in order to discuss and to depict the future research developments and tendencies. Despite considerable research efforts, from this investigation come many issues worthy of further investigation, such as how to prevent or minimize tribocorrosion in biological tribopairs, the development of a consolidated protocol for tribological experiments in corrosive environments joined with new biomaterials and composites, the possibility to achieve more and more accurate theoretical models, and how to be able to ensure the success of new implant designs by supporting research and development for the management of implant complications. The above issues certainly constitute a scientific challenge for the next years in the fields of tribology and medicine.
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22
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Leveraging physical intelligence for the self-design of high performance engineering structures. Sci Rep 2022; 12:11640. [PMID: 35803987 PMCID: PMC9270372 DOI: 10.1038/s41598-022-15229-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/21/2022] [Indexed: 11/08/2022] Open
Abstract
The design of complex engineering structures largely relies on computational intelligence in the form of science-based predictive models to support design decisions. This approach requires modeling and manufacturing uncertainties to be accounted for explicitly and leads to an inescapable trade-off of performance for robustness. To remedy this situation, a novel self-design paradigm is proposed that closes the loop between the design and manufacturing processes by leveraging physical intelligence in the form of real-time experimental observations. This allows the real-time product behavior to participate in its own design. The main benefit of the proposed paradigm is that both manufacturing variability and difficult-to-model physics are accounted for implicitly via in situ measurements thus circumventing the performance-robustness trade-off and guaranteeing enhanced performance with respect to standardized designs. This paradigm shift leads to tailored design realizations which could benefit a wide range of high performance engineering applications. The proposed paradigm is applied to the design of a simply-supported plate with a beam-like absorber introduced to reduce vibrations based on an equal peaks performance criteria. The experimental setup includes a low-cost 3D printer driven by a simple decision algorithm and equipped with an online vibration testing system. The performances of a small population of self-designed plates are compared to their standardized counterparts in order to highlight the advantages and limitations of the new self-design manufacturing paradigm.
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23
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Mechanical force-promoted osteoclastic differentiation via periodontal ligament stem cell exosomal protein ANXA3. Stem Cell Reports 2022; 17:1842-1858. [PMID: 35868309 PMCID: PMC9391435 DOI: 10.1016/j.stemcr.2022.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/16/2022] Open
Abstract
Exosomes play a critical role in intracellular communication. The biogenesis and function of exosomes are regulated by multiple biochemical factors. In the present study, we find that mechanical force promotes the biogenesis of exosomes derived from periodontal ligament stem cells (PDLSCs) and alters the exosomal proteome profile to induce osteoclastic differentiation. Mechanistically, mechanical force increases the level of exosomal proteins, especially annexin A3 (ANXA3), which facilitates exosome internalization to activate extracellular signal-regulated kinase (ERK), thus inducing osteoclast differentiation. Moreover, the infusion of exosomes derived from PDLSCs into mice promotes mechanical force-induced tooth movement and increases osteoclasts in the periodontal ligament. Collectively, this study demonstrates that mechanical force treatment promotes the biogenesis of exosomes from PDLSCs and increases exosomal protein ANXA3 to facilitate exosome internalization, which activates ERK phosphorylation, thus inducing osteoclast differentiation. Our findings shed light on new mechanisms for how mechanical force regulates the biology of exosomes and bone metabolism. Mechanical force promotes the biogenesis of exosomes derived from PDLSCs by RAB27B Mechanical force increases exosomal protein ANXA3 to facilitate exosome internalization ANXA3 activates ERK phosphorylation to induce osteoclast differentiation PDLSC exosomes enhance mechanical force-induced tooth movement
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Batool S, Hammami M, Mantebea H, Badar F, Xia Y. Location-Specific Study of Young Rabbit Femoral Cartilage by Quantitative µMRI and Polarized Light Microscopy. Cartilage 2022; 13:19476035221085143. [PMID: 35306861 PMCID: PMC9137317 DOI: 10.1177/19476035221085143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Microscopic magnetic resonance imaging (µMRI) and polarized light microscopy (PLM) are used to characterize the structural variations at different anatomical locations of femoral cartilage in young rabbits (12-14 weeks old). DESIGN Four intact knees were imaged by µMRI at 86 µm resolution. Three small cartilage-bone specimens were harvested from each of 2 femoral medial condyles and imaged by quantitative µMRI (T2 anisotropy) at 9.75 µm resolution (N = 6). These specimens, as well as the other 2 intact femoral condyles, were used for histology and imaged by quantitative PLM (retardation and angle) at 0.25 µm to 4 µm resolutions. RESULTS Quantitative MRI relaxation data and PLM fibril data revealed collaboratively distinct topographical variations in both cartilage thickness and its collagen organization in the juvenile joint. Cartilage characteristics from the central location have a 3-zone arcade-like fibril structure and a distinct magic angle effect, commonly seen in mature articular cartilage, while cartilage at the anterior location lacks these characteristics. Overall, the lowest retardation values and isotropic T2 values have been found in the distal femur (trochlear ridge), with predominant parallel fibers with respect to the articular surface. Central cartilage is the thickest (~550 µm), approximately twice as thick as the anterior and posterior locations. CONCLUSION Distinctly different characteristics of tissue properties were found in cartilage at different topographical locations on femoral condyle in rabbits. Knowledge of location-specific structural differences in the collagen network over the joint surface can improve the understanding of local mechanobiology and provide insights to tissue engineering and degradation repairs.
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Affiliation(s)
- Syeda Batool
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Mouhamad Hammami
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Hannah Mantebea
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Farid Badar
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Yang Xia
- Department of Physics, Center for Biomedical Research, Oakland University, Rochester, MI, USA,Yang Xia, Department of Physics, Center for Biomedical Research, Oakland University, 244 Meadow Brook Road, Rochester, MI 48309, USA.
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25
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Li Z, Xu G, Wang C, Wang Q, Liu C, Guo T, Wu L, Cao D. Variation characteristics of stress distribution in the subchondral bone of the knee joint of judo athletes with long-term stress changes. Front Endocrinol (Lausanne) 2022; 13:1082799. [PMID: 36778597 PMCID: PMC9909959 DOI: 10.3389/fendo.2022.1082799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To investigate the distribution of bone density in the subchondral bone tissue of the knee joint due to the mechanical stress load generated by judo, the bone tissue volume of different densities and the bone remodeling characteristics of the subchondral bone of the knee joint. METHODS CT imaging data of the knee joint were collected from 15 healthy individuals as controls and 15 elite judo athletes. Firstly, they were processed by the CTOAM technique, and secondly, the distribution pattern of high-density areas of the knee joint was localized using nine anatomical regions. In addition, three tomographic images were selected in the sagittal, coronal, and axial 2D image windows to observe the distribution of different densities of bone tissue. Finally, the percentage of bone tissue volume (%BTV) and bone remodeling trend of bone tissues with different densities were determined. RESULTS In this study, high-density areas were found in the 4th, 5th, and 6th regions of the articular surface of the distal femur and the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th and 8th regions of the tibial plateau in judo athletes; the distribution of high-density areas on the articular surface of the distal femur in control subjects was similar with judo athletes, and high-density areas were mainly found in the 4th and 5th regions of the tibial plateau. The %BTV of low (401-500HU in the distal femur; 301-400 HU and 401-500HU in the tibial plateau), moderate, and high bone density was higher in judo athletes than in controls in the subchondral bone of the distal femur and tibial plateau (P< 0.05). CONCLUSION The history of compressive stresses, struck stresses, soft tissue tension and pull, self-gravity and intra-articular stress loading generated by the lower limb exercise technique of judo leads to specific forms of stress distribution and bone tissue remodeling in the subchondral bone tissue within the distal femur and tibia plateau.
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Affiliation(s)
- Zhiqiang Li
- School of Physical Education, North University of China, Taiyuan, China
| | - Guanghua Xu
- School of Physical Education, North University of China, Taiyuan, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chengjun Wang
- School of Physical Education, North University of China, Taiyuan, China
| | - Qiuyuan Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Caiping Liu
- School of Physical Education, North University of China, Taiyuan, China
| | - Tingting Guo
- Ergonomics and Functional Clothing Laboratory, School of Textiles and Fashion, Shanghai University of Engineering Science, Shanghai, China
| | - Lijun Wu
- School of Physical Education, Shanxi University, Taiyuan, China
- *Correspondence: Diankang Cao, ; Lijun Wu,
| | - Diankang Cao
- School of Physical Education, North University of China, Taiyuan, China
- *Correspondence: Diankang Cao, ; Lijun Wu,
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26
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Beckers L, Dandois F, Ooms D, Berger P, Van Laere K, Scheys L, Vandenneucker H. Assessment of in vivo bone activity patterns in medial mobile-bearing unicompartmental knee arthroplasty : a prospective SPECT/CT study. Bone Joint J 2022; 104-B:34-44. [PMID: 34969270 DOI: 10.1302/0301-620x.104b1.bjj-2021-0121.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Higher osteoblastic bone activity is expected in aseptic loosening and painful unicompartmental knee arthroplasty (UKA). However, insights into normal bone activity patterns after medial UKAs are lacking. The aim of this study was to identify the evolution in bone activity pattern in well-functioning medial mobile-bearing UKAs. METHODS In total, 34 patients (13 female, 21 male; mean age 62 years (41 to 79); BMI 29.7 kg/m2 (23.6 to 42.1)) with 38 medial Oxford partial UKAs (20 left, 18 right; 19 cementless, 14 cemented, and five hybrid) were prospectively followed with sequential 99mTc-hydroxymethane diphosphonate single photon emission CT (SPECT)/CT preoperatively, and at one and two years postoperatively. Changes in mean osteoblastic activity were investigated using a tracer localization scheme with volumes of interest (VOIs), reported by normalized mean tracer values. A SPECT/CT registration platform additionally explored cortical tracer evolution in zones of interest identified by previous experimental research. RESULTS Significant reduction of tracer activity from the preoperative situation was found in femoral and anteromedial tibial VOIs adjacent to the UKA components. Temporarily increased osteoblastic bone activity was observed in VOIs comprising the UKA keel structure at one year postoperatively compared to the preoperative activity. Persistent higher tracer uptake was found in the posterior tibial cortex at final follow-up. Multivariate analysis showed no statistical difference in osteoblastic bone activity underneath cemented or cementless components. CONCLUSION Well-functioning medial mobile-bearing UKAs showed distinct changes in patterns of normalized bone tracer activity in the different VOIs adjacent to the prosthetic components, regardless of their type of fixation. Compared to the preoperative situation, persistent high bone activity was found underneath the keel and the posterior tibial cortex at final follow-up, with significant reduced activity only being identified in femoral and anteromedial tibial VOIs. Cite this article: Bone Joint J 2022;104-B(1):34-44.
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Affiliation(s)
- Lucas Beckers
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Félix Dandois
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Dirk Ooms
- Department of Nuclear Medicine and Molecular Imaging, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium.,Department of Nuclear Medicine, OLV Ziekenhuis Campus Aalst, Aalst, Belgium
| | - Pieter Berger
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Koen Van Laere
- Department of Nuclear Medicine and Molecular Imaging, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Lennart Scheys
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
| | - Hilde Vandenneucker
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), Leuven, Belgium
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27
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Yin XY, Chung JY, Park DY, Song HK, Kim BK, Bae HW, Park KH, Min BH. The Perimensical Capsule: Potential Supporting Structure Surrounding Meniscus. Cartilage 2021; 13:208S-215S. [PMID: 31810381 PMCID: PMC8808842 DOI: 10.1177/1947603519892316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study analyzed the morphological and biomechanical characteristics of perimeniscal capsule in knee joint thus establishing the roles of these tissues. A total of 10 human cadaver knees were used in this study. Medial meniscus and the adjacently surrounding joint capsules were harvested then sectioned both axially and coronally, followed by scanning electron microscopy analysis. The medial meniscus (anterior, middle, posterior) and the adjacent perimeniscal capsules (superior, peripheral) were biomechanically assessed to ascertain the tensile modulus. Among the perimeniscal capsules, the peripherally located capsules were morphologically different from the superiorly located capsules: The peripheral perimeniscal capsule was thicker and showed circumferentially oriented fibers whereas the superior perimeniscal capsule fibers were thinner and arranged in vertical orientation. The peripheral capsule also yielded significantly greater tensile modulus compared with the superior capsule biomechanically. We conclude that depending on its anatomical location, the perimeniscal capsule consists of fibers of varying orientations. This may be important in maintaining the circumferential hoop tension of the meniscus especially in the presence of circumferentially oriented and thick peripheral capsule fibers, which coincidentally have higher tensile modulus.
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Affiliation(s)
- Xiang Yun Yin
- Department of Orthopedic Surgery, Ajou
University School of Medicine, Suwon, Korea,Cell Therapy Center, Ajou University Medical
Center, Suwon, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou
University School of Medicine, Suwon, Korea
| | - Do Young Park
- Department of Orthopedic Surgery, Ajou
University School of Medicine, Suwon, Korea,Cell Therapy Center, Ajou University Medical
Center, Suwon, Korea
| | - Hyung Keun Song
- Department of Orthopedic Surgery, Ajou
University School of Medicine, Suwon, Korea
| | - Byeong Kook Kim
- Department of Biomedical Engineering, Pukyong
National University, Busan, Korea
| | - Hee Won Bae
- Department of Orthopedic Surgery, Ajou
University School of Medicine, Suwon, Korea
| | - Ki Hoon Park
- Department of Orthopedic Surgery, Ajou
University School of Medicine, Suwon, Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, Ajou
University School of Medicine, Suwon, Korea,Cell Therapy Center, Ajou University Medical
Center, Suwon, Korea,Department of Molecular Science and
Technology, Ajou University College of Engineering, Suwon, Korea,Byoung-Hyun Min, Department of Orthopedic Surgery,
Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea.
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28
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Ren L, Yang Z, Wang Y, Basanta S, Du B, Gao Z, Hao B, Chen R. Comparison of Minimally Invasive Fixation of Mid-Shaft Clavicular Fractures with Threaded Elastic Intramedullary Nail (TEIN) and Elastic Locking Intramedullary Nail (ELIN). Orthop Surg 2021; 13:2111-2118. [PMID: 34605612 PMCID: PMC8528980 DOI: 10.1111/os.13129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of threaded elastic intramedullary nail and elastic locking intradullary nail (ELIN) for mid-shaft clavicular fractures. METHODS The clinical data of 47 patients with middle clavicle fracture treated by TEIN and ELIN from August 2017 to March 2019 were analyzed retrospectively. Twenty-three patients received intramedullary fixation treatment with ELIN, nine males and 14 females, AO/OTA fracture classification type 2A (n = 17) and 2B (n = 6). Twenty-four patients received intramedullary fixation treatment with TEIN, including nine males and 15 females, AO/OTA classification: type 2A (n = 18) and 2B (n = 6). All patients were anesthetized with ipsilateral cervical plexus block. After internal fixation was removed, the clinical outcomes were assessed and evaluated. The Constant-Murley score and disabilities of the arm, shoulder and hand questionnaire (DASH) score were compared between the two groups to evaluate the functional status of all patients. The study was done accordingly to the guidelines provided by the ethics committee. RESULTS All patients in the two groups completed the operation successfully and were followed up. In the ELIN group, the operation time was 20.78 ± 7.71 min, intra-operative blood loss was 13.26 ± 9.72 mL, incision length was 1.60 ± 0.92 cm, internal fixation removal time was 12.86 ± 2.24 weeks, Constant-Murley score was 99.30 ± 1.36 points and DASH score was 1.43 ± 3.00 points. In the TEIN group, the operation time, intra-operative blood loss, incision length, internal fixation removal time, Constant-Murley and DASH scores were 22.83 ± 8.17 min, 22.08 ± 11.22 mL, 2.48 ± 0.84 cm, 15.66 ± 5.58 weeks, 95.79 ± 7.38 point and 6.69 ± 11.55 point respectively. In the ELIN group, four cases developed skin irritation, and the symptoms were relieved after removal of internal fixation. In the TEIN group, one patient's internal fixation broke and had an obvious scar at the incision, but there was no fracture after replacement of internal fixation; withdrawal of TEIN occurred in four patients, the nail did not shift again until the last follow-up; skin irritation and temporary bursitis occurred in six patients, and the symptoms were relieved after internal fixation was removed. No other conditions were found in the patients, and bony healing was achieved in all patients. CONCLUSION ELIN prevents shortening and malunion of the clavicle, reduces secondary damage to related tissues, and leads to restoration of clavicle length and faster osseous healing.
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Affiliation(s)
- Liang Ren
- School of Chinese Integrated Chinese and Western MedicinesTianjin University of Traditional Chinese MedicineTianjinChina
| | - Zhiqiang Yang
- Orthopaedics DepartmentThe Fourth Central Hospital Affiliated to Nankai UniversityTianjinChina
| | - Yongqing Wang
- Huazhong University of Science and TechnologyTianjinChina
| | - Sapkota Basanta
- Orthopaedics DepartmentThe Fourth Central Hospital Affiliated to Nankai UniversityTianjinChina
| | - Bosong Du
- Orthopaedics DepartmentThe Fourth Central Hospital Affiliated to Nankai UniversityTianjinChina
| | | | - Baoxi Hao
- Orthopaedics DepartmentThe Fourth Central Hospital Affiliated to Nankai UniversityTianjinChina
| | - Renhui Chen
- Orthopaedics DepartmentThe Fourth Central Hospital Affiliated to Nankai UniversityTianjinChina
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29
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Pirosa A, Tankus EB, Mainardi A, Occhetta P, Dönges L, Baum C, Rasponi M, Martin I, Barbero A. Modeling In Vitro Osteoarthritis Phenotypes in a Vascularized Bone Model Based on a Bone-Marrow Derived Mesenchymal Cell Line and Endothelial Cells. Int J Mol Sci 2021; 22:ijms22179581. [PMID: 34502489 PMCID: PMC8430538 DOI: 10.3390/ijms22179581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
The subchondral bone and its associated vasculature play an important role in the onset of osteoarthritis (OA). Integration of different aspects of the OA environment into multi-cellular and complex human, in vitro models is therefore needed to properly represent the pathology. In this study, we exploited a mesenchymal stromal cell line/endothelial cell co-culture to produce an in vitro human model of vascularized osteogenic tissue. A cocktail of inflammatory cytokines, or conditioned medium from mechanically-induced OA engineered microcartilage, was administered to this vascularized bone model to mimic the inflamed OA environment, hypothesizing that these treatments could induce the onset of specific pathological traits. Exposure to the inflammatory factors led to increased network formation by endothelial cells, reminiscent of the abnormal angiogenesis found in OA subchondral bone, demineralization of the constructs, and increased collagen production, signs of OA related bone sclerosis. Furthermore, inflammation led to augmented expression of osteogenic (alkaline phosphatase (ALP) and osteocalcin (OCN)) and angiogenic (vascular endothelial growth factor (VEGF)) genes. The treatment, with a conditioned medium from the mechanically-induced OA engineered microcartilage, also caused increased demineralization and expression of ALP, OCN, ADAMTS5, and VEGF; however, changes in network formation by endothelial cells were not observed in this second case, suggesting a possible different mechanism of action in inducing OA-like phenotypes. We propose that this vascularized bone model could represent a first step for the in vitro study of bone changes under OA mimicking conditions and possibly serve as a tool in testing anti-OA drugs.
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Affiliation(s)
- Alessandro Pirosa
- Department of Biomedicine, University Hospital Basel, University of Basel, 4056 Basel, Switzerland; (A.P.); (E.B.T.); (A.M.); (L.D.); (I.M.)
| | - Esma Bahar Tankus
- Department of Biomedicine, University Hospital Basel, University of Basel, 4056 Basel, Switzerland; (A.P.); (E.B.T.); (A.M.); (L.D.); (I.M.)
| | - Andrea Mainardi
- Department of Biomedicine, University Hospital Basel, University of Basel, 4056 Basel, Switzerland; (A.P.); (E.B.T.); (A.M.); (L.D.); (I.M.)
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (P.O.); (M.R.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Paola Occhetta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (P.O.); (M.R.)
| | - Laura Dönges
- Department of Biomedicine, University Hospital Basel, University of Basel, 4056 Basel, Switzerland; (A.P.); (E.B.T.); (A.M.); (L.D.); (I.M.)
| | - Cornelia Baum
- Department of Orthopaedic Surgery and Traumatology, University Hospital Basel, 4031 Basel, Switzerland;
- Department of Research and Development, Schulthess Klinik Zurich, 8008 Zurich, Switzerland
| | - Marco Rasponi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (P.O.); (M.R.)
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, 4056 Basel, Switzerland; (A.P.); (E.B.T.); (A.M.); (L.D.); (I.M.)
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, 4056 Basel, Switzerland; (A.P.); (E.B.T.); (A.M.); (L.D.); (I.M.)
- Correspondence:
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The mechanical influence of bone spicules in the osteochondral junction: A finite element modelling study. Biomech Model Mechanobiol 2021; 20:2335-2351. [PMID: 34468916 DOI: 10.1007/s10237-021-01510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
While much has been done to study how cartilage responds to mechanical loading, as well as modelling such responses, arguably less has been accomplished around the mechanics of the cartilage-bone junction. Previously, it has been reported that the presence of bony spicules invading the zone of calcified cartilage, preceded the formation of new subchondral bone and the advancing of the cement line (Thambyah and Broom in Osteoarthr Cartil 17:456-463, 2009). In this study, the morphology and frequency of bone spicules in the cartilage-bone interface of osteochondral beams subjected to three-point bending were modelled, and the results are discussed within the context of biomechanical theories on bone formation. It was found that the stress and strain magnitudes, and their distribution were sensitive to the presence and number of spicules. Spicule numbers and shape were shown to affect the strain energy density (SED) distribution in the areas of the cement line adjacent to spicules. Stresses, strains and SED analyses thus provided evidence that the mechanical environment with the addition of spicules promotes bone formation in the cartilage-bone junction.
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Fluid-structure interaction (FSI) modeling of bone marrow through trabecular bone structure under compression. Biomech Model Mechanobiol 2021; 20:957-968. [PMID: 33547975 DOI: 10.1007/s10237-021-01423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
The present study has sought to investigate the fluid characteristic and mechanical properties of trabecular bone using fluid-structure interaction (FSI) approach under different trabecular bone orientations. This method imposed on trabecular bone structure at both longitudinal and transverse orientations to identify effects on shear stress, permeability, stiffness and stress regarded to the trabeculae. Sixteen FSI models were performed on different range trabecular cubes of 27 mm3 with eight models developed for each longitudinal and transverse direction. Results show that there was a moderate correlation between permeability and porosity, and surface area in the longitudinal and transverse orientations. For the longitudinal orientation, the permeability values varied between 3.66 × 10-8 and 1.9 × 10-7 and the sheer stress values varied between 0.05 and 1.8 Pa, whilst for the transverse orientation, the permeability values varied between 5.95 × 10-10 and 1.78 × 10-8 and the shear stress values varied between 0.04 and 3.1 Pa. Here, transverse orientation limits the fluid flow from passing through the trabeculae due to high shear stress disturbance generated within the trabecular bone region. Compared to physiological loading direction (longitudinal orientation), permeability is higher within the range known to trigger a response in bone cells. Additionally, shear stresses also increase with bone surface area. This study suggests the shear stress within bone marrow in real trabecular architecture could provide the mechanical signal to marrow cells that leads to bone anabolism and can depend on trabecular orientation.
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Zhu X, Chan YT, Yung PSH, Tuan RS, Jiang Y. Subchondral Bone Remodeling: A Therapeutic Target for Osteoarthritis. Front Cell Dev Biol 2021; 8:607764. [PMID: 33553146 PMCID: PMC7859330 DOI: 10.3389/fcell.2020.607764] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/28/2020] [Indexed: 12/21/2022] Open
Abstract
There is emerging awareness that subchondral bone remodeling plays an important role in the development of osteoarthritis (OA). This review presents recent investigations on the cellular and molecular mechanism of subchondral bone remodeling, and summarizes the current interventions and potential therapeutic targets related to OA subchondral bone remodeling. The first part of this review covers key cells and molecular mediators involved in subchondral bone remodeling (osteoclasts, osteoblasts, osteocytes, bone extracellular matrix, vascularization, nerve innervation, and related signaling pathways). The second part of this review describes candidate treatments for OA subchondral bone remodeling, including the use of bone-acting reagents and the application of regenerative therapies. Currently available clinical OA therapies and known responses in subchondral bone remodeling are summarized as a basis for the investigation of potential therapeutic mediators.
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Affiliation(s)
- Xiaobo Zhu
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yau Tsz Chan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick S H Yung
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Rocky S Tuan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yangzi Jiang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Hounsfield Unit for Assessing Vertebral Bone Quality and Asymmetrical Vertebral Degeneration in Degenerative Lumbar Scoliosis. Spine (Phila Pa 1976) 2020; 45:1559-1566. [PMID: 32756284 DOI: 10.1097/brs.0000000000003639] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES The aim of this study was to demonstrate the correlation between degenerative lumbar scoliosis (DLS) and osteoporosis based on Hounsfield unit (HU) measurement from computed tomography (CT) scans, and to investigate the asymmetrical vertebral degeneration in DLS. SUMMARY OF BACKGROUND DATA The correlation between DLS and osteoporosis measured by dual-energy x-ray absorptiometry (DEXA) is debated, since T-scores measured by DEXA scan can be overestimated due to abdominal vessel wall calcification, degenerative bony spurs, and facet hypertrophy. The reliability and accuracy of HU to determine osteoporosis are shown in many reports, but it has never been used to assess the vertebral bone quality for DLS patients. METHODS Nighty-five DLS patients were retrospectively reviewed. Regions of interest for HU were measured on three coronal images of the lumbar vertebrae. HU measurement of the whole vertebrae from L1 to L5 was obtained, then HU measurement within concave and convex sides were obtained separately in L5, upper and lower end vertebrae, apex vertebrae, neutral vertebrae, stable vertebrae. RESULTS HU value presented a gradually increasing trend from L1 to L5. No correlation was detected between Cobb angle and mean HU value of the 5 lumbar vertebrae, or between Cobb angle and HU value of every lumbar vertebrae separately. HU value was higher within concavity than that within convexity of the same vertebrae both in major and compensatory curve. Asymmetric HU ratio in apex vertebrae positively correlated with Cobb angle. Stable vertebrae were the first proximal vertebrae that present opposite orientation of asymmetric HU ratio from the other lumbar vertebrae. CONCLUSION Progression of degenerative scoliosis presents no correlation with osteoporosis based on HU measurement but could increase the asymmetrical vertebral degeneration, especially in apex vertebrae. Distraction of the pedicle screws at concave side, instead of compression of pedicle screws at convex side, should be a priority to correct lumbosacral curve. LEVEL OF EVIDENCE 3.
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Kantha P, Tsai SC, Hou CW, Yang RS, Su PY, Hsu WL. Relationship Between Body Composition and Balance Performance in Older Adults with Hyperkyphosis. J Med Biol Eng 2020. [DOI: 10.1007/s40846-020-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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夏 燊, 赵 泽, 徐 永, 吕 乾, 浦 绍, 陈 汉, 齐 欣, 朱 跃. [Anatomical calcaneal external fixator self-designed according to the morphology of heel]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:475-481. [PMID: 32291984 PMCID: PMC8171517 DOI: 10.7507/1002-1892.201908149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The anatomical calcaneal external fixator was designed by measuring and calculating the morphological data of the heel. METHODS A total of 100 normal people were randomly selected to obtain 200 hind foot data, including 45 males and 55 females, with an average age of 43.9 years (range, 19-67 years). According to the principles of human engineering and local anatomy, the morphological data of the heel in the weight-bearing standing position and supine position were measured with the direct measurement mode. The heel length, heel width, heel height, medial ankle height, lateral ankle height, and calcaneal pitch angle (CPA) were measured by vernier calipers and ulnar markers in weight-bearing standing position, and the gender groups and left and right foot groups were compared; the shape of the hind foot in the supine position was measured by three-dimensional (3D) dot matrix inverse model method. According to the stereoscopic data of the comprehensive anatomical morphology of the heel, the anatomical calcaneal external fixator was designed with AutoCAD 2019 and other 3D industrial design softwares. RESULTS The measurements of shoe size, heel length, heel width, heel height, medial ankle height, lateral ankle height, and CPA in male were significantly higher than those in female ( P<0.05). There was no significant difference between the left and right feet in the other indexes except that the height of the medial malleolus of the left foot was significantly lower than that of the right foot ( t=-2.827, P=0.005). The measurement of 3D dot matrix inverse model in supine position showed that the heel part was non-circular arc edge, and many groups of arc edges fluctuate in a limited range. Based on the above data, an anatomical calcaneal external fixator was designed, which could fit the anatomic radian in theory, so as to be flexible in configuration. On this basis, the ordinary configuration, compression configuration, and orthodontic configuration were designed to meet the treatment needs of calcaneal fractures in different degrees. The ordinary configuration was suitable for patients with Sanders Ⅰ, ⅡA, and ⅡB calcaneal fractures with no or slight displacement of intra-articular fractures; the ordinary configuration was mainly used for simple fixing. The compression configuration was suitable for patients with Sanders ⅡC, ⅢA, and ⅢB, tongue fractures, and avulsion fractures with severe displacement of intra-articular fractures; the compression configuration used obliquely drawn console wires to fix the displaced bones. The orthodontic configuration was suitable for patients with Sanders ⅢC and Ⅳ calcaneal fractures with severe displacement of intra-articular fractures or severe calcaneal bone defects; the orthodontic configuration was a multi-module design, which took into account the stable fixation of the fracture and the arbitrary adjustment of the joint fixation angle. CONCLUSION The hind foot is special for morphology, so the external fixator designed based on the vernier caliper measurement method and 3D dot matrix measuring plate measurement method is an anatomical type and its configuration can theoretically meet stable and flexible clinical needs.
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Affiliation(s)
- 燊 夏
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 泽雨 赵
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 永清 徐
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 乾 吕
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 绍全 浦
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 汉芬 陈
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 欣 齐
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 跃良 朱
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
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The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review. J Funct Biomater 2020; 11:jfb11020025. [PMID: 32290191 PMCID: PMC7353497 DOI: 10.3390/jfb11020025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023] Open
Abstract
Poly(methyl methacrylate) (PMMA) is widely used in joint arthroplasty to secure an implant to the host bone. Complications including fracture, bone loss and infection might cause failure of total knee arthroplasty (TKA), resulting in the need for revision total knee arthroplasty (rTKA). The goals of this paper are: (1) to identify the most common complications, outside of sepsis, arising from the application of PMMA following rTKA, (2) to discuss the current applications and drawbacks of employing PMMA in managing bone loss, (3) to review the role of PMMA in addressing bone infection following complications in rTKA. Papers published between 1970 to 2018 have been considered through searching in Springer, Google Scholar, IEEE Xplore, Engineering village, PubMed and weblinks. This review considers the use of PMMA as both a bone void filler and as a spacer material in two-stage revision. To manage bone loss, PMMA is widely used to fill peripheral bone defects whose depth is less than 5 mm and covers less than 50% of the bone surface. Treatment of bone infections with PMMA is mainly for two-stage rTKA where antibiotic-loaded PMMA is inserted as a spacer. This review also shows that using antibiotic-loaded PMMA might cause complications such as toxicity to surrounding tissue, incomplete antibiotic agent release from the PMMA, roughness and bacterial colonization on the surface of PMMA. Although PMMA is the only commercial bone cement used in rTKA, there are concerns associated with using PMMA following rTKA. More research and clinical studies are needed to address these complications.
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Wang LJ, Zeng N, Yan ZP, Li JT, Ni GX. Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther 2020; 22:57. [PMID: 32209130 PMCID: PMC7092615 DOI: 10.1186/s13075-020-02156-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/16/2020] [Indexed: 02/08/2023] Open
Abstract
Post-traumatic osteoarthritis (PTOA) develops after joint injury. Specifically, patients with anterior cruciate ligament (ACL) injury have a high risk of developing PTOA. In this review, we outline the incidence of ACL injury that progresses to PTOA, analyze the role of ACL reconstruction in preventing PTOA, suggest possible mechanisms thought to be responsible for PTOA, evaluate current diagnostic methods for detecting early OA, and discuss potential interventions to combat PTOA. We also identify important directions for future research. Although much work has been done, the incidence of PTOA among patients with a history of ACL injury remains high due to the complexity of ACL injury progression to PTOA, the lack of sensitive and easily accessible diagnostic methods to detect OA development, and the limitations of current treatments. A number of factors are thought to be involved in the underlying mechanism, including structural factors, biological factors, mechanical factors, and neuromuscular factor. Since there is a clear "start point" for PTOA, early detection and intervention is of great importance. Currently, imaging modalities and specific biomarkers allow early detection of PTOA. However, none of them is both sensitive and easily accessible. After ACL injury, many patients undergo surgical reconstruction of ACL to restore joint stability and prevent excessive loading. However, convincing evidence is still lacking for the superiority of ACL-R to conservative management in term of the incidence of PTOA. As for non-surgical treatment such as anti-cytokine and chemokine interventions, most of them are investigated in animal studies and have not been applied to humans. A complete understanding of mechanisms to stratify the patients into different subgroups on the basis of risk factors is critical. And the improvement of standardized and quantitative assessment techniques is necessary to guide intervention. Moreover, treatments targeted toward different pathogenic pathways may be crucial to the management of PTOA in the future.
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Affiliation(s)
- Li-Juan Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Ni Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Peng Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie-Ting Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
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Ullah K, Khan S, Wang YQ, Zhao ZH, Cheng P, Sapkota B, Ren L, Khan S, Rehman MU, Xue Y. Bilaterally Threaded, Minimal Invasive, Elastic Locking Intramedullary Nailing (ELIN) for the Treatment of Clavicle Fractures. Orthop Surg 2020; 12:321-332. [PMID: 32077261 PMCID: PMC7031594 DOI: 10.1111/os.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate and present the effectiveness of this innovatively designed, elastic locking intramedullary nail (ELIN) in fixation of clavicle fractures. Methods The study included 38 patients from July 2014 to July 2017. All of them received intramedullary fixation treated with ELIN, 22 were males and 16 females. The mean age of the patients was 54 years. There were twenty right‐side and 18 left‐side clavicular fractures. Radiographs were taken to assess the fracture type: 21 were type A, 16 type B, and one type C. General anesthesia or cervical block was given to all patients. A small incision of 3–5 cm was given only to those who needed mini‐open reduction. The administration of ELIN and reduction of the fracture was made sure with a C arm machine. After a follow‐up of 8 to 33 months, the clinical outcomes were assessed and evaluated. The constant scores and disabilities of the arm, shoulder and hand questionnaire (DASH) were used to determine the outcomes and functional status of the patients. The study was done accordingly to the guidelines provided by the ethics committee. Results Mean operation time was 25.63 min. Mean follow‐up time was 16.5 months. The rate of closed reduction and open reduction was 84% and 16% respectively. There was no shortening of the clavicle. There was no breakage of the nail, though bending of the nail occurred in one patient. Superficial skin infection occurred in three patients at insertion points or the nail tip which was embedded subcutaneously. Skin erosion with nail exposure occurred in a patient with no significant infection. All the other patients had excellent shoulder function. A mini scar was observed in seven patients all the other patients had no scar. Asymmetry was observed in three patients. The mean Constant score was 98.47 and the mean DASH score was 1.55 at the last follow‐up. The implant was removed in all the patients. Conclusion Clavicular fractures treated with ELIN is minimally invasive, which presents a safe and novel surgical technique with less complications and a high success rate, excellent aesthetic and quick recovery after surgery. ELIN restores the micro‐dynamic stress at the fracture ends and promotes fracture healing, keeps intact the fracture hematoma and maintains the blood supply, accelerates healing and thus leads to faster osseous healing and better restoration of clavicle length.
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Affiliation(s)
- Kifayat Ullah
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Saima Khan
- Department of Infertility and Reproductive Endocrinology, Tianjin Medical University Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Yong-Qing Wang
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Zhi-Hui Zhao
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Peng Cheng
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | | | - Liang Ren
- Department of Orthopedic Surgery, Tianjin Fourth Central Hospital, Tianjin Medical University, Tianjin, China
| | - Samiullah Khan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mujeeb Ur Rehman
- Department of Cardiovascular and Thoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Okano I, Carlson BB, Chiapparelli E, Salzmann SN, Winter F, Shirahata T, Miller CO, Rentenberge C, Shue J, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Local Mechanical Environment and Spinal Trabecular Volumetric Bone Mineral Density Measured by Quantitative Computed Tomography: A Study on Lumbar Lordosis. World Neurosurg 2019; 135:e286-e292. [PMID: 31790845 DOI: 10.1016/j.wneu.2019.11.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There have been some reports on the association between spinal balance parameters and regional bone mineral density (BMD), but the results are controversial. The purpose of this study is to evaluate the relationship between spinopelvic parameters and regional volumetric BMDs (vBMDs) measured by quantitative computed tomography (QCT) in the lumbosacral region of patients undergoing lumbar fusion surgery. METHODS The data of consecutive patients undergoing posterior lumbar spinal fusion with preoperative computed tomography was reviewed. QCT measurements were conducted in L1-S1 vertebral trabecular bone. The associations between spinopelvic sagittal parameters and vBMDs were evaluated. Multivariate analyses adjusted with age, gender, race, and body mass index were conducted with vBMD as the response variable. RESULTS A total of 144 patients were included in the final analyses. Mean age (± standard deviation) was 65.4 ± 11.8 years. Mean vBMD in L1 (± standard deviation) was 118.3 ± 37.4 mg/cm3. After adjusting by cofactors, lumbar lordosis was negatively associated with vBMDs in all levels from L1 to L5 (% regression coefficients and adjusted R2 values: L1, -0.438, 0.268; L2, -0.556, 0.296; L3, -0.608, 0.362; L4, -0.554, 0.228; L5, -0.424, 0.194), but not in S1. Sacral slope was negatively associated with vBMD only at L4 (% coefficient, -0.588; R2, 0.208). Other parameters were not significantly associated with vBMDs at any levels. CONCLUSIONS Higher lumbar lordosis was associated with lower vBMDs in all lumbar spine levels. Our results suggest that BMD is affected not only by metabolic factors but also by the mechanical environment. Further longitudinal studies are needed to elucidate this effect of vBMD on clinical outcomes.
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Affiliation(s)
- Ichiro Okano
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Brandon B Carlson
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA; Marc A. Asher, MD, Comprehensive Spine Center, University of Kansas, Kansas City, Kansas, USA
| | - Erika Chiapparelli
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Stephan N Salzmann
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Fabian Winter
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Toshiyuki Shirahata
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | | | | | - Jennifer Shue
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Andrew A Sama
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Frank P Cammisa
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Federico P Girardi
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA
| | - Alexander P Hughes
- Spine Care Service, Hospital for Special Surgery, New York, New York, USA.
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Afolabi HA, Zakaria ZB, Hashim MNM, Vinayak CR, Ahmed Shokri AB. Body Mass Index and predisposition of patients to knee osteoarthritis. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.obmed.2019.100143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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41
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Beckers L, Ooms D, Berger P, Van Laere K, Scheys L, Vandenneucker H. Reduced bone activity in the native compartments after medial mobile-bearing unicompartmental knee arthroplasty. A prospective SPECT/CT study. Bone Joint J 2019; 101-B:915-921. [PMID: 31362550 DOI: 10.1302/0301-620x.101b8.bjj-2018-1569.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Altered alignment and biomechanics are thought to contribute to the progression of osteoarthritis (OA) in the native compartments after medial unicompartmental knee arthroplasty (UKA). The aim of this study was to evaluate the bone activity and remodelling in the lateral tibiofemoral and patellofemoral compartment after medial mobile-bearing UKA. PATIENTS AND METHODS In total, 24 patients (nine female, 15 male) with 25 medial Oxford UKAs (13 left, 12 right) were prospectively followed with sequential 99mTc-hydroxymethane diphosphonate single photon emission CT (SPECT)/CT preoperatively and at one and two years postoperatively, along with standard radiographs and clinical outcome scores. The mean patient age was 62 years (40 to 78) and the mean body mass index (BMI) was 29.7 kg/m2 (23.6 to 42.2). Mean osteoblastic activity was evaluated using a tracer localization scheme with volumes of interest (VOIs). Normalized mean tracer values were calculated as the ratio between the mean tracer activity in a VOI and background activity in the femoral diaphysis. RESULTS Significant reduction of normalized tracer activity was observed one year postoperatively in tibial and femoral VOIs adjacent to the joint line in the lateral compartment. Patellar VOIs and remaining femoral VOIs demonstrated a significant, diminished normalized tracer activity at final follow-up. CONCLUSION The osteoblastic bone activity in the native compartments decreased significantly after treatment of medial end-stage OA with a UKA, implying reduced stress to the subchondral bone in the retained compartments after a UKA. Cite this article: Bone Joint J 2019;101-B:915-921.
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Affiliation(s)
- L Beckers
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), UZLeuven, Leuven, Belgium
| | - D Ooms
- KULeuven/University Hospitals Leuven, Department of Nuclear Medicine and Molecular Imaging, UZLeuven, Leuven, Belgium
| | - P Berger
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), UZLeuven, Leuven, Belgium
| | - K Van Laere
- KULeuven/University Hospitals Leuven, Department of Nuclear Medicine and Molecular Imaging, UZLeuven, Leuven, Belgium
| | - L Scheys
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), UZLeuven, Leuven, Belgium
| | - H Vandenneucker
- KULeuven/University Hospitals Leuven, Institute for Orthopaedic Research and Training (IORT), UZLeuven, Leuven, Belgium
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Hellem A, Shirley M, Schilaty N, Dahm D. Review of Shoulder Range of Motion in the Throwing Athlete: Distinguishing Normal Adaptations from Pathologic Deficits. Curr Rev Musculoskelet Med 2019; 12:346-355. [PMID: 31264172 PMCID: PMC6684718 DOI: 10.1007/s12178-019-09563-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Overhand (OH) throwers demonstrate a unique motion profile of the shoulder joint complex. This manuscript reviews normal adaptations in the OH thrower and contrast findings with pathologic motion deficits. RECENT FINDINGS Multiple adaptations in range of motion have been associated with increased risk for arm injury. The use of a more conservative cutoff value for glenohumeral internal rotation deficit and horizontal adduction in younger throwers may help reduce injury risk. Deficits in glenohumeral internal rotation, total range of motion, shoulder flexion, and external rotation insufficiency have all been proposed as means to identify OH throwers at risk for arm injury, but conflicting evidence exists. Understanding normal adaptation due to repetitive stress of throwing is essential to effective management of these athletes. Adaptive change in bone and soft tissues is normal and contributes to the unique motion profiles expected in throwers. The causative link between normal adaptation and shoulder and elbow injury remains uncertain.
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Affiliation(s)
- Aaron Hellem
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center at Mayo Clinic Square, Mayo Clinic, 600 Hennepin Avenue #310, Minneapolis, MN, 55403, USA.
| | - Matthew Shirley
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Nathan Schilaty
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Diane Dahm
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
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Becker SK. Evaluating elbow osteoarthritis within the prehistoric Tiwanaku state using generalized estimating equations (GEE). AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 169:186-196. [PMID: 30821354 DOI: 10.1002/ajpa.23806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 01/26/2019] [Accepted: 02/08/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Studies of osteoarthritis (OA) in human skeletal remains can come with scalar problems. If OA measurement is noted as present or absent in one joint, like the elbow, results may not identify specific articular pathology data and the sample size may be insufficient to address research questions. If calculated on a per data point basis (i.e., each articular surface within a joint), results may prove too data heavy to comprehensively understand arthritic changes, or one individual with multiple positive scores may skew results and violate the data independence required for statistical tests. The objective of this article is to show that the statistical methodology Generalized Estimating Equations (GEE) can solve scalar issues in bioarchaeological studies. MATERIALS AND METHODS Using GEE, a population-averaged statistical model, 1,195 adults from the core and one colony of the prehistoric Tiwanaku state (AD 500-1,100) were evaluated bilaterally for OA on the seven articular surfaces of the elbow joint. RESULTS GEE linked the articular surfaces within each individual specimen, permitting the largest possible unbiased dataset, and showed significant differences between core and colony Tiwanaku peoples in the overall elbow joint, while also pinpointing specific articular surfaces with OA. Data groupings by sex and age at death also demonstrated significant variation. A pattern of elbow rotation noted for core Tiwanaku people may indicate a specific pattern of movement. DISCUSSION GEE is effective and should be encouraged in bioarchaeological studies as a way to address scalar issues and to retain all pathology information.
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Affiliation(s)
- Sara K Becker
- Department of Anthropology, University of California, Riverside, Riverside, California
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Pardey D, Tabor G, Oxley JA, Wills AP. Peak forelimb ground reaction forces experienced by dogs jumping from a simulated car boot. Vet Rec 2018; 182:716. [PMID: 29622683 DOI: 10.1136/vr.104788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 11/04/2022]
Abstract
Many dog owners allow their pets to jump out of a car boot; however, to date, there has been no study that has investigated whether this places dogs at risk of injury. The aim of this study was to investigate the relationship between height and peak vertical ground reaction force (vGRF) in static start jumps. Fifteen healthy adult dogs performed three jumps from a platform that represented common vehicle boot sill heights (0.55, 0.65, 0.75 m), landing on a single force platform. Kinetic data (mediolateral (Fx), craniocaudal (Fy) and vertical (Fz)) were normalised for body weight and analysed via a one-way repeated analysis of variance (ANOVA) and pairwise post hoc tests with a Bonferroni correction applied. There was a significant difference in peak forelimb vGRF between both the 0.55 m (27.35±4.14 N/kg) and the 0.65 m (30.84±3.66 N/kg) platform (P=0.001) and between the 0.65 and 0.75 m (34.12±3.63 N/kg) platform (P=0.001). There was no significant difference in mediolateral or craniocaudal forces between the heights examined. These results suggest that allowing dogs to jump from bigger cars with a higher boot sill may result in augmented levels of loading on anatomical structures. Further research is required to investigate the kinematic effects of height on static jump-down and how peak forelimb vGRF relates to anatomical loading and subsequent injury risk.
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Affiliation(s)
- David Pardey
- Animal Welfare Research and Knowledge Exchange Arena, Department of Animal and Agriculture, Hartpury University Centre, Gloucester, UK
| | - Gillian Tabor
- Animal Welfare Research and Knowledge Exchange Arena, Department of Animal and Agriculture, Hartpury University Centre, Gloucester, UK
| | | | - Alison P Wills
- Animal Welfare Research and Knowledge Exchange Arena, Department of Animal and Agriculture, Hartpury University Centre, Gloucester, UK
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Suzuki T, Sukezaki F, Shibuki T, Toyoshima Y, Nagai T, Inagaki K. Teriparatide Administration Increases Periprosthetic Bone Mineral Density After Total Knee Arthroplasty: A Prospective Study. J Arthroplasty 2018; 33:79-85. [PMID: 28869116 DOI: 10.1016/j.arth.2017.07.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Teriparatide is a currently available therapeutic agent for osteoporosis. Previous studies have reported that teriparatide affects periprosthetic bone mineral density (BMD) after total knee arthroplasty (TKA). However, little agreement has been reached concerning the treatment of periprosthetic BMD after TKA with teriparatide. Moreover, BMD in the femoral and tibial sides of the joints together has never been examined. We investigated the efficacy of teriparatide to inhibit BMD loss in the femoral and tibial side and considered complications such as migration and periprosthetic fractures after TKA. METHODS Twenty-two knees in 17 patients were included in this study, and a control group of patients who underwent TKA was identified according to their medical records. Dual-energy X-ray absorptiometry was performed for different locations (knee, hip, and lumbar spine), and regions of interest were measured to estimate BMD at initiation of the study as a baseline reference, followed by subsequent measurements at 6 and 12 months. RESULTS As a result of adjusting the difference between the BMDs of the 2 groups at initiation, there was a significant increase in R3 (posterior condyle) and R4 (lateral) at 6 months. Furthermore, there was a significant increase in R2 (anterior condyle), R3 (posterior condyle), and R6 (tibial diaphysis) at 12 months. The study group had a higher adjusted mean BMD in all regions than did the control group at 6 and 12 months. CONCLUSION Teriparatide may be a reasonable treatment option for osteoporotic patients to preserve or improve periprosthetic BMD after TKA.
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Affiliation(s)
- Tatsuya Suzuki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Fumio Sukezaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Shibuki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yoichi Toyoshima
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Nagai
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Effect of Acupotomy on FAK-PI3K Signaling Pathways in KOA Rabbit Articular Cartilages. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:4535326. [PMID: 29234400 PMCID: PMC5660818 DOI: 10.1155/2017/4535326] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/28/2017] [Indexed: 11/18/2022]
Abstract
Objective By observing the needle-knife of KOA rabbit morphology, knee joint cartilage p-FAK, p-PI3K, Aggrecan gene, and protein expression, to study the effect of needle-knife to promote cartilage cell synthesis metabolism mechanism. Method 49 male New Zealand rabbits, randomly divided into normal group (Z), model group (M), model-inhibitors (MP), needle-knife group (D), needle-knife inhibitors group (DP), electroacupuncture group (E), and electroacupuncture inhibitors (EP). RT-PCR and Western Blot were used to test each animal cartilage p-FAK, p-PI3K, and Aggrecan gene and protein expression level. Results Compared with N group, p-FAK and p-PI3K protein and mRNA expression of M group, D group, and E group increased (P < 0.05), while the protein and mRNA expression of Aggrecan reduced (P < 0.05). Compared with M group, p-FAK, p-PI3K, Aggrecan protein, and mRNA of E and D group increased (P < 0.05). Compared with E group, p-FAK, p-PI3K, Aggrecan protein, and mRNA expression of D group increased (P < 0.05); after adding inhibitors, p-FAK, p-PI3K, Aggrecan protein, and mRNA expression reduced (P < 0.05). Conclusion Needle-knife therapy can promote the repairment of cartilage cells by activating FAK-PI3K signaling pathways, promoting the synthesis of cartilage cell metabolism.
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Raman spectral characteristics of neck and head of femur in low-density lipoprotein receptor gene knockout mice submitted to treadmill aerobic training. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 173:92-98. [DOI: 10.1016/j.jphotobiol.2017.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/13/2017] [Accepted: 05/14/2017] [Indexed: 11/18/2022]
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Agarwal V, Smuck M, Shah NH. Quantifying the relative change in physical activity after Total Knee Arthroplasty using accelerometer based measurements. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2017; 2017:463-472. [PMID: 28815146 PMCID: PMC5543365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Osteoarthritis is amongst the top five most disabling conditions affecting Americans over 65 years of age and imposes an annual economic burden estimated at $ 89.1 billion. Nearly half of the cost of care of Osteoarthritis is attributable to hospitalizations for total knee arthroplasties (TKA) and total hip arthroplasties (THA). The current clinical practice relies predominantly on subjective assessment of physical function and pain via patient reported outcome measures (PROM) that have proven inadequate for providing a validated, reliable and responsive measure of TKA outcomes. Wearable activity monitors, which produce a trace of regularly monitored physical activity derived from accelerometer measurements, provide a novel opportunity to objectively assess physical functional status in Osteoarthritis patients. Using data from the Osteoarthritis Initiative (OAI), we demonstrate the feasibility of quantifying the relative change in physical activity patterns in Osteoarthritis subjects using accelerometer based measurements of daily physical activity.
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Affiliation(s)
- Vibhu Agarwal
- Biomedical Informatics Training Program Stanford University, CA, USA
| | - Mathew Smuck
- Stanford University Hospital and Clinics, Stanford, CA, USA
| | - Nigam H. Shah
- Center for Biomedical Informatics Research, Stanford University, CA, USA
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Kraeutler MJ, Mitchell JJ, Chahla J, McCarty EC, Pascual-Garrido C. Intra-articular Implantation of Mesenchymal Stem Cells, Part 2: A Review of the Literature for Meniscal Regeneration. Orthop J Sports Med 2017; 5:2325967116680814. [PMID: 28203596 PMCID: PMC5298485 DOI: 10.1177/2325967116680814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Knee osteoarthritis (OA) after partial or total meniscectomy is a prevalent issue that patients must face. Various methods of replacing meniscal tissue have been studied to avoid this progression, including meniscal allograft transplantation, meniscal scaffolds, and synthetic meniscus replacement. Studies have shown that meniscal scaffolds may improve symptoms but have not been shown to prevent progression of OA. Recently, mesenchymal stem cells (MSCs) have been proposed as a possible biological therapy for meniscal regeneration. Several animal studies and 1 human study have evaluated the effect of transplanting MSCs into the knee joint after partial meniscectomy. The purpose of this review was to assess the outcomes of intra-articular transplantation of MSCs on meniscal regeneration in animals and humans after partial meniscectomy. Limited results from animal studies suggest that there is some potential for intra-articular injection of MSCs for the regeneration of meniscal tissue. However, further studies are necessary to determine the quality of regenerated meniscal tissue through histological and biomechanical testing.
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Affiliation(s)
- Matthew J Kraeutler
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
| | - Justin J Mitchell
- Gundersen Health System, Department of Sports Medicine, La Crosse, Wisconsin, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
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Teichtahl AJ, Cicuttini FM. Editorial: Pain Relief in Osteoarthritis: The Potential for a Perfect Storm. Arthritis Rheumatol 2016; 68:270-3. [DOI: 10.1002/art.39493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/20/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew J. Teichtahl
- Monash University School of Public Health and Preventive Medicine, Alfred Hospital, and Baker IDI Heart and Diabetes Institute; Melbourne, Victoria Australia
| | - Flavia M. Cicuttini
- Monash University School of Public Health and Preventive Medicine and Alfred Hospital; Melbourne, Victoria Australia
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